Taking gunner to the next level? (Stanford poisoning)

[NontradCA]

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I am NEVER competitive, ever. There is no instance in my life that I need to be, in the past, present and future, where I would have to do an ounce of competition. I can't come up with an example in my entire life where I had to compete, and can't come up with an example in the future. So, honestly, I can't relate to the people who are competitive, I can understand, but I will NEVER be in their shoes in my entire life. I think it's just the culture of undergrad, and certain people. I am the furthest from Type A you can be, so maybe that explains it.

How has that worked out for you throughout med school and residency up to this point?

 

[KnuxNole]

How has that worked out for you throughout med school and residency up to this point?

Perfectly fine. There was 0 ounces of competition during my 4 years, for me. For others, possibly, like alluded in the above discussion, but that didn't affect me in a million years. I basically studied hard, learned all the material, did well on Step 1 +2(which is based on my studying, irregardless of what everyone does), did well on rotations(which is fairly easy, show up, work hard, smile, be interested in resident/attending's lives), got great LORs, lots of interviews, matched in my #3 on my ROL(anything in 1-5 would have been awesome, I only ranked places I liked, did not rank some) and graduated feeling accomplished that I finished med school, have a career and feeling happy. The above, was stuff that I only did for me, and throughout the 4 years, did not even think the word competition was EVEN CLOSE in my vocabulary or made any impact whatsoever to where I currently am at. In residency, obviously there isn't anything I see that would have competition, so that is null. Same with eventually being an attending and just living life to the fullest and being happy.

 

[deleted500612]

If you need to compete with others in med school, you must truly suck, are that pathetic or can't do med school the normal way, lol.

Anyone who has ever looked at their class average on an exam and felt any emotion, whether positive or negative, is competing with others. Competing does not have to be actively gunning/sabotaging classmates. Most med students are competitive in at least a more subtle/subconscious capacity. If you are even slightly concerned with where you stand in regards to classmates, you are competing. I would say a majority of med students fall into that category. Maybe at true pass/fail schools that do not release class averages or any exam statistics would be exempted from fostering that competitive mind set, but I think those schools are definitely in the minority.

 

[KnuxNole]

Anyone who has ever looked at their class average on an exam and felt any emotion, whether positive or negative, is competing with others. Competing does not have to be actively gunning/sabotaging classmates. Most med students are competitive in at least a more subtle/subconscious capacity. If you are even slightly concerned with where you stand in regards to classmates, you are competing. I would say a majority of med students fall into that category. Maybe at true pass/fail schools that do not release class averages or any exam statistics would be exempted from fostering that competitive mind set, but I think those schools are definitely in the minority.

True, that is a good point. I'm someone who did not care about class averages for 1 millisecond(the only way to find out is when the professor talks about it, which my respond was "oh, that's nice" or "oh, that sucks"), so in that regards, I can see how I don't connect or relate to most of the lot here.

 

[Nasrudin]

What does psych do with patients like this? And any other that fall under axis 2 that are less than pleasant to be around? What if they actually do need help? And recognize they are manipulative and destructive?

Well in this case it's obvious. A forensic psych, maybe one for both sides, will weigh in on the insanity plea. In other words, either you understand what you were doing or you have a legitimate illness that makes you not responsible, entirely, for your actions.

In general, from what I've heard, the insanity plea is a high bar to meet. Many scuzzball defendants try it, very few win a case for it.

As far as psych treatment is concerned we face pathological personality structure just as often as ED docs do. They often come in threatening suicide if they don't get a bed for the night, sometimes after they're going to get discharged from Med ED for some other BS complaint. It's our job to figure out if they're FOS or if they're serious and are depressed.

Other times they might have legitimate mental illness and personality pathology. Just like you could have HTN and personality pathology.

We have to treat the mental illness just like an IM doc has to treat the medical problems aside from the personality stuff.

As far as treatment for the personality problems it's usually talk therapy. Sometimes Boderlines can present psychotic or with other mood problems so personality structure is an important part of our formulations. They're necessary to consider to avoid medicating when medications are not likely to help. Among other reasons.

For antisocial/narcissist type patients who get committed to locked inpatient units special precautions are sometimes necessary to prevent violence to staff and other patients. Treatment for these patients in terms of talk therapy is difficult and should be approached cognitively in terms of building insight into less disruptive behaviors for their life--the focus is on managing their lack of empathy rather than trying to instill empathy.

Many of these people are very high functioning and can often excel in fields where empathy is a liability of sorts.

 

[Stagg737]

I am NEVER competitive, ever. There is no instance in my life that I need to be, in the past, present and future, where I would have to do an ounce of competition. I can't come up with an example in my entire life where I had to compete, and can't come up with an example in the future. So, honestly, I can't relate to the people who are competitive, I can understand, but I will NEVER be in their shoes in my entire life. I think it's just the culture of undergrad, and certain people. I am the furthest from Type A you can be, so maybe that explains it.

You have been involved with competition whether you like it or not. Getting into med school or even undergrad for that matter is a competition. It's you versus every other applicant. You have to be better than them in the eyes of the place you're applying to in order to get in and 'win'. Maybe you don't see it as competition, but to a certain extent that's exactly what it is. If you've truly never felt like you competed with people before then you are either:

a) Someone with some kind of emotional disorder/shortcoming in which you lack the ability to feel those emotions
b) A total anomaly to the human race and evolution in general
c) Buddha himself (or something close to it)
d) Full of s***

I'm guessing it's probably a combination of a and b, possibly with a little bit of d thrown in (though you might not realize it). You do also realize that a person can compete with him or herself right? Have you really never had that urge to do better, or to improve yourself to the point that you wanted to work hard to achieve that? Because that's a form of competition, even if it is completely intrinsic.

 

[KnuxNole]

We'll have to agree to disagree. I haven't felt like undergrad was a competition or getting into med school. Undergrad was where I learned about myself, met amazing people, did messed up stuff, and had some sweet classes. Whatever grades I got where what I got. I never once in my entire life felt like I was ever competing with other people. In a way, yes, I have to be "better than them" to get into med school, but what they did had 0 impact on my life. For most people, they had competed with others, but I haven't experience that feeling in my life. For getting into med school, I was focused on my own goals, and whatever happens happens.

So yes, you are correct, getting into med school can be a competition. Maybe a better way to explain my side is: To me, it didn't FEEL like a competition. Even though I was technically competing, I never once felt like that. Especially with that timeframe, there were more important things going on in my life, that at times, it was put on the backburner.

And no, I've never really had a competitive drive. I can't think of one instance in my life where that has ever occurred. I suppose I'm the opposite of a lot of people. I just try to be happy and live, being thankful I'm alive and still surviving.

 

[Stagg737]

I guess we are pretty much just opposites, as I really don't understand how people can never compete at anything. I love to compete, and I compete in some way with almost everything I do. Is it relaxing to just clear your mind and just exist every once in a while? Sure. But when I do that for too long I either start getting content and letting my goals slip or, much more often, I get bored out of my mind and start finding ways to compete with myself. I really don't get how some people can continue pushing themselves, doing things they don't enjoy without creating some kind of competition. Even if it is just with yourself to improve what you already know.

 

[PL198]

Well in this case it's obvious. A forensic psych, maybe one for both sides, will weigh in on the insanity plea. In other words, either you understand what you were doing or you have a legitimate illness that makes you not responsible, entirely, for your actions.

In general, from what I've heard, the insanity plea is a high bar to meet. Many scuzzball defendants try it, very few win a case for it.

As far as psych treatment is concerned we face pathological personality structure just as often as ED docs do. They often come in threatening suicide if they don't get a bed for the night, sometimes after they're going to get discharged from Med ED for some other BS complaint. It's our job to figure out if they're FOS or if they're serious and are depressed.

Other times they might have legitimate mental illness and personality pathology. Just like you could have HTN and personality pathology.

We have to treat the mental illness just like an IM doc has to treat the medical problems aside from the personality stuff.

As far as treatment for the personality problems it's usually talk therapy. Sometimes Boderlines can present psychotic or with other mood problems so personality structure is an important part of our formulations. They're necessary to consider to avoid medicating when medications are not likely to help. Among other reasons.

For antisocial/narcissist type patients who get committed to locked inpatient units special precautions are sometimes necessary to prevent violence to staff and other patients. Treatment for these patients in terms of talk therapy is difficult and should be approached cognitively in terms of building insight into less disruptive behaviors for their life--the focus is on managing their lack of empathy rather than trying to instill empathy.

Many of these people are very high functioning and can often excel in fields where empathy is a liability of sorts.

Except people don't claim to have heart attacks to get out of punishment. It sounds like you're pushing a psych diagnosis on the person already. All I see from psych is an expansion of every diagnosis and an attempt to basically be able to call anyone mentally ill at any time. That's the reason it doesn't get good press in my mind, the constant bs about spectrums and the fact that I could call you mentally ill if I had 5 spectrums in front of me and spend an hour interviewing you.

 

[username456789]

Yeah, honestly this seems quite in line with how this usually goes. A person does something terrible, then their public excuse tries to fall back on some form of self victimization, painting themselves as suffering with an illness that we should all understand and be compassionate about. It's a great last ditch effort at appealing for sympathy. Yes, this behavior is rather pathologic, but it is also standard of practice in the media, and almost certainly pushed by attorneys as well.

I guess what I'm saying is, it doesn't seem at all surprising or alarming to hear this excuse. It's just a typical script.

 

[NontradCA]

Except people don't claim to have heart attacks to get out of punishment. It sounds like you're pushing a psych diagnosis on the person already. All I see from psych is an expansion of every diagnosis and an attempt to basically be able to call anyone mentally ill at any time. That's the reason it doesn't get good press in my mind, the constant bs about spectrums and the fact that I could call you mentally ill if I had 5 spectrums in front of me and spend an hour interviewing you.

He didn't imply that at all. I thought he gave a great summary of axis 2 patients, and described the process of pleading insanity briefly, without going into diagnoses. I think you read something that wasn't there.

 

[Nasrudin]

Except people don't claim to have heart attacks to get out of punishment. It sounds like you're pushing a psych diagnosis on the person already. All I see from psych is an expansion of every diagnosis and an attempt to basically be able to call anyone mentally ill at any time. That's the reason it doesn't get good press in my mind, the constant bs about spectrums and the fact that I could call you mentally ill if I had 5 spectrums in front of me and spend an hour interviewing you.

I'm saying its suspicious for criminal behavior of the sort that does not arise from mental Illness. Also I'm saying I would love to be courtside when or if a forensic psychiatrist takes the stand.

Your protestations to my field are noted. As per previously.

 

[KnuxNole]

I guess we are pretty much just opposites, as I really don't understand how people can never compete at anything. I love to compete, and I compete in some way with almost everything I do. Is it relaxing to just clear your mind and just exist every once in a while? Sure. But when I do that for too long I either start getting content and letting my goals slip or, much more often, I get bored out of my mind and start finding ways to compete with myself. I really don't get how some people can continue pushing themselves, doing things they don't enjoy without creating some kind of competition. Even if it is just with yourself to improve what you already know.

For me, if I really don't enjoy something, I would try to fix it so that I make it more enjoyable. Or, if it is temporary(being stuck in something that is soul sucking forever is not for me), take my mind off of it until it passes like a kidney stones, and life is good again!

 

[Stagg737]

For me, if I really don't enjoy something, I would try to fix it so that I make it more enjoyable. Or, if it is temporary(being stuck in something that is soul sucking forever is not for me), take my mind off of it until it passes like a kidney stones, and life is good again!

How do you fix that though? Honestly, I really don't know how to force myself to like something that I don't like unless I turn it into some kind of competition or a game (which usually is some kind of competition, at least with myself). I'm genuinely curious, as I struggle to make things that I really don't care about into 'fun'.

 

[charmiedermie]

Yes, extremes may be rare, such as the article above, but competition itself is nature. Plenty of students do secretly compete with one another, regardless of what we believe. Why do you think P/F is nice, as is not being graded relative to classmates? A big part is because we naturally compare ourselves to others. In our profession, suicide and depression are high, and are often contributed to individuals feeling incompetent/imposters relative to others. This is actually a major issue. Students may not take it to the extreme on the outside, but even amongst friends, scores in school are often the most common way for young individuals to define themselves, and therefore, lower scores relative to peers often have psychological side effects. As you get older and more into training, sure, you learn to let go. But keep in mind that many students are fresh out of college, where they just spent years avoiding being weeded out, or being beaten by the curve.

Of course, there are always external factors to take into consideration, but competition among students is not a "rare" thing. You may be collegial with your classmates, even the best of friends. But as I originally said, there are plenty of students with insecurities, imposter/inferiority syndromes and complexes, who are historically used to competing and defining themselves by their achievements. Regardless of how they come across on the outside.

Also, you cannot say that "they suck because if they were smart or did well, they don't have to worry about competing". In fact, very intelligent people are often the most likely to compete, because they are consistently aware of how much they do not know. They think up intricate problems and situations for which they don't know the answers, and freak out. They remember minute details and problems that others won't even think of, and they worry that everybody around them knows the answers, are they are the only ones left in the dark. They tend to be deep thinkers, who often understand, process, and apply information very well. They're just too neurotic.

Roll your eyes, call them paranoid, it's all the same. It doesn't change the fact that many humans compare themselves to others, worry about not achieving certain standards, have a deep-rooted fear of failure and inadequacy/insecurity, and often show no obvious external indicators. Not everybody that competes is a gunner. Competition is normal. I would disagree with you to say that there is no competition, or, that there's no way we have to compete with others. Sometimes we do; just not necessarily in the ways we expect people to, such as poisoning or screwing people over in other ways.

So, because you don't feel the same way they do, you're going to call people with insecurities "douches"?

People can be competitive without cutting you down or rubbing it your face. It can be a quiet, personal taking of theirs.

Also, please reread what I wrote. I never said intelligent people all do this. The previous poster said that people who compete are dumb, and I was making the point that he's not necessarily correct. Many people who are so insecure are actually very intelligent. It's sort of like when "dumb" people think they know everything. A smart individual understands is aware that they only know little of the information out there, and they constantly think about that, and it can lead to insecurities.

My point is that being competitive is not "rare", and it does not make somebody a douchebag. Are you going to refer to some of your psych patients as douchebags? According to my point, you might, because judgement is normal, but you should also be aware of those judgements and work to understand.

That is correct. My point was in response to a previous poster saying that people who compete in medical school are dumb, pathetic, and that it's rare, and another person referring to a competitive person in medical school as a douche.

Of course, a person may be these things. I suppose we're arguing different ideas. But yes, I agree that any competition that actually has an effect on others (effect to sabotage them), is certainly wrong.

I never said they can't be obnoxious. I'm not even discussing how they carry themselves. I'm saying that competition is not uncommon in medical school.

And please clarify, "You don't have people saying the things you are saying out loud. If it was a widely accepted modality, then we'd talk about it more openly..". I just want to make sure I'm not misinterpreting what you're saying.

Wanting to be top, however, can be mutually exclusive with wanting others to fail. Some people very much respect the achievements of others, and therefore, by doing even better, they feel better. You can wish the best for your classmates, but also feel like complete crap if you are not at least on par, or maybe even better than them. Even if you have different career goals. Yes, call it insecurity, whatever. The point is that you don't pull others down to do better; that is called gunning. You push yourself to be higher than them.

Also, the school you go to can have an influence on this. Some schools attract certain personality types, so that may be the cause of the discrepancy we are seeing between our view points. However, it important to understand that, regardless of what you see on the outside, being competitive is not uncommon on the inside.

You stated earlier that it's not widely accepted, because we don't openly discuss it. Perhaps we don't talk about it because many people feel insecure and/or they compete, and are afraid of being called "douches".

Why shouldn't people be afraid of being called a douche? People are afraid of being socially ostracized, and that makes sense. Everyone is afraid of developing a bad reputation among others. It certainly has repercussions.

And have you never seriously heard of a group mentality? People that associate with one another will often tend to have similar views about a single person. In this case, it's people that are calling other competitive people douches. Yes, sometimes that person is a douche.


But is the single person being called out actually a douche, or is it the people that are so concerned with labeling others as douches, that are douches themselves?

Anyone who has ever looked at their class average on an exam and felt any emotion, whether positive or negative, is competing with others. Competing does not have to be actively gunning/sabotaging classmates. Most med students are competitive in at least a more subtle/subconscious capacity. If you are even slightly concerned with where you stand in regards to classmates, you are competing. I would say a majority of med students fall into that category. Maybe at true pass/fail schools that do not release class averages or any exam statistics would be exempted from fostering that competitive mind set, but I think those schools are definitely in the minority.

I'm amazed by the number of people who can't understand your post/posts.

 

[Bloodmoney]

The perpetrator is the sole determiner of his own destiny and needs to be held accountable. However, I believe psych diagnoses are often used not just to release the criminal from accountability, but also to release the community from any accountability. The psych diagnosis is a measure of how far the personality deviates from the norm, but people establish baseline norm personalities through repeated positive social interactions with other healthy people. I think even people who commit serious criminal acts could have gone another path if the community makes continued efforts to socialize them normally despite awkwardness. Most of us take for granted that we have a safe place to go home to where we don't have to worry about being physically, verbally, or mentally abused; at least a few trusted loved ones and friends to listen to us and validate our feelings; enough money for food to eat and a soft bed to sleep on. Not having any one of those things is enough to cause someone to present as psychotic. Just watch any homeless person you see on the street talking to himself.

 

[Nasrudin]

The perpetrator is the sole determiner of his own destiny and needs to be held accountable. However, I believe psych diagnoses are often used not just to release the criminal from accountability, but also to release the community from any accountability. The psych diagnosis is a measure of how far the personality deviates from the norm, but people establish baseline norm personalities through repeated positive social interactions with other healthy people. I think even people who commit serious criminal acts could have gone another path if the community makes continued efforts to socialize them normally despite awkwardness. Most of us take for granted that we have a safe place to go home to where we don't have to worry about being physically, verbally, or mentally abused; at least a few trusted loved ones and friends to listen to us and validate our feelings; enough money for food to eat and a soft bed to sleep on. Not having any one of those things is enough to cause someone to present as psychotic. Just watch any homeless person you see on the street talking to himself.

This is a collage of ideas that are crammed together.

The first is the nature of free will itself which you question if it really exists or are we all pieces of hardware running the various software systems downloaded onto our existence. I don't disagree. Or at least the question is something that I wonder about too.

But psychiatric diagnoses describe states that alter functioning. What causes these states is still up for grabs. Some component of environmental and societal factors acting on the genome in a particular human's development to varying degrees, depending on the diagnosis. We treat the individual state because, as you rightly suggest, treating the society is enormously more difficult. But also to some extent irreversible.

Take an antisocial personality with a violent criminal record for example. We should have compassion for this defective state devoid of the bonds that enrich and harmonize the lives of the rest of us. But...that doesn't mean we let them roam free in society if they've done harm to others when we have every reason clinically and legally to prevent them from doing so again.

With regard to people responding to AH that you see on the street they're likely schizophrenic, Bipolar manic, drug induced psychotic, delusional, shizotypal, or some other route to being psychotic. If they're in these states long enough to affect their functioning they often will exhaust their family supports or didn't have them to start with or perhaps left them behind for any number of psychotic reasons, and have become homeless. Being homeless would not make you or I psychotic.

It is true that supportive human networks and community can make prognosis for psychotic disorders much better but the direct link to this or that factor is unlikely. There are people who think there is a huge cultural basis for differing rates of psychotic illnesses but I'm not convinced of that. The incidence stability seems to suggest some other etiologic phenomenon.

 

[Kaustikos]

PFA in water? Come on. At least make it a cocktail with juice.

 

[Bloodmoney]

I have never had a PFA drink so maybe it is not terrible who knows

 

[Bloodmoney]

Interested to know your thoughts on this article http://mobile.nytimes.com/2010/01/10/magazine/10psyche-t.html?referrer=&_r=0
I have thought about this all morning, and I concede that you would be correct in a certain percentage of cases. I want to believe these idealistic notions, but yes trying to treat society is probably a waste of time. I can't imagine that people who hear voices telling them to commit crimes might in different circumstance not have heard those voices. I have mad respect for people in the psych profession. Very challenging and underappreciated field. If you read Shakespeare though and take away that Hamlet had these qualities from the DSM V and probably should have taken some pills for that anxiety it would probably be missing the point of the story.

This is a collage of ideas that are crammed together.

The first is the nature of free will itself which you question if it really exists or are we all pieces of hardware running the various software systems downloaded onto our existence. I don't disagree. Or at least the question is something that I wonder about too.

But psychiatric diagnoses describe states that alter functioning. What causes these states is still up for grabs. Some component of environmental and societal factors acting on the genome in a particular human's development to varying degrees, depending on the diagnosis. We treat the individual state because, as you rightly suggest, treating the society is enormously more difficult. But also to some extent irreversible.

Take an antisocial personality with a violent criminal record for example. We should have compassion for this defective state devoid of the bonds that enrich and harmonize the lives of the rest of us. But...that doesn't mean we let them roam free in society if they've done harm to others when we have every reason clinically and legally to prevent them from doing so again.

With regard to people responding to AH that you see on the street they're likely schizophrenic, Bipolar manic, drug induced psychotic, delusional, shizotypal, or some other route to being psychotic. If they're in these states long enough to affect their functioning they often will exhaust their family supports or didn't have them to start with or perhaps left them behind for any number of psychotic reasons, and have become homeless. Being homeless would not make you or I psychotic.

It is true that supportive human networks and community can make prognosis for psychotic disorders much better but the direct link to this or that factor is unlikely. There are people who think there is a huge cultural basis for differing rates of psychotic illnesses but I'm not convinced of that. The incidence stability seems to suggest some other etiologic phenomenon.[/QUOTE